ACS TQIP Benchmark Report:All Patients2010 Admissions
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ACS TQIP Benchmark Report: All TQIP Patients 2010 Admissions
Table of Contents
Introduction ......................................................................................................... 2
Facility Characteristics ....................................................................................... 3
Patient Characteristics ....................................................................................... 4
Inter-Hospital Comparisons ............................................................................. 13
Data Quality .............................................................................................................................. 13
Limitations of Interfacility Comparisons ............................................................................... 13
Risk Adjusted Mortality ........................................................................................................... 14
Risk Adjusted Length of Stay ................................................................................................. 33
Appendix A: Participating Hospitals .............................................................. 52
Appendix B: ACS TQIP Patient Inclusion/Exclusion Criteria ....................... 54
Appendix C: Prediction Models ....................................................................... 55
Appendix D: ....................................................................................................... 60
TQIP Team ................................................................................................................................ 60
TQIP Leadership ...................................................................................................................... 61
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Introduction This is the third benchmark report for the 2011 program year. Thus far in 2011, we have presented reports on patients with TBI, and shock from 2009. This report represents the first to use data from 2010 admissions. The next report will present outcomes in the elderly trauma patient. The ACS TQIP analysis is based on selected trauma incidents submitted to NTDB. By choosing incidents based on standard selection criteria, we minimize variability across trauma centers in the analysis and provide more accurate inter-facility comparisons. This report is based on 2010 NTDB admissions, including a total of 85,569 incidents that meet TQIP inclusion/exclusion criteria (see Appendix B), from 113 TQIP centers. The ACS TQIP reports on all incidents that meet the inclusion criteria and on two distinct subsets of severely injured patients derived from this population. These subsets were selected to reflect the wide spectrum of trauma patients and their varied challenges. It also provides an opportunity for centers with significant over-representation of a particular type of patient to better understand their performance relative to their peers. The subsets are as follows: Subset 1- Blunt multisystem injury: Trauma type classified as blunt with injuries of AIS ≥ 3 in at least two of the following AIS body regions: head, face, neck, thorax, abdomen, spine, and upper and lower extremities. Subset 2 – Penetrating truncal injury: Trauma type classified as penetrating with injuries of AIS ≥ 3 in at least one of the following AIS body regions: neck, chest, or abdomen. The selection of the blunt multisystem trauma subset allows for the assessment of many processes and outcomes related to inter-disciplinary management including critical care, neurosurgery, and orthopedic surgery. By contrast, the penetrating trauma subset allows for evaluation of processes and outcomes related to clinical judgment, timely operative management, and general surgical technical skills. In addition, to allow for more meaningful length of stay (LOS) comparisons, we present excess length of stay for two homogeneous patient populations: isolated pneumothorax and isolated midshaft femur fractures. New in this report We no longer present data on the subset of patients previously identified as “blunt single system injury”. Injuries in this category varied dramatically across centers, with some centers having a preponderance of lower extremity injuries and others were primarily traumatic brain injuries. As a result, we concluded that the inter-hospital comparisons of this subset did not help identify opportunities for improvement. This report begins by presenting aggregate information about TQIP hospitals and patients. The analysis that follows focuses on risk adjusted models for mortality and length of stay. Inter-hospital comparisons are illustrated on a series of caterpillar graphs, with more detailed information available in tabular form.
Thanks to all of you for participating in the ACS TQIP this year. We look forward to your thoughts about this report and to our continued work together on improving the care of injured patients.
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Facility Characteristics
Figure 1. Trauma Level Figure 2. Bed Size
Two-thirds of TQIP trauma centers are ACS verified or state designated Level I centers. Over 40% of TQIP centers have a bed size of more than 600. Figure 3. Teaching Type Figure 4. Hospital Type
Most TQIP centers are university teaching hospitals, and nearly as many are community teaching hospitals. 95% of TQIP centers are not-profit.
I 66%
II 34%
<=2003%
201‐40026%
401‐60030%
>60041%
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Facility Characteristics
Figure 5. US Census Region
TQIP centers are distributed throughout the US, with most centers situated in the Midwest and South. See Appendix A for a listing of all participating centers.
Patient Characteristics
Figure 6. TQIP Patients
There were 85,569 patients from participating centers that met TQIP inclusion criteria and were admitted in 2010. (See Appendix B). Of those 85,569 patients, about 20% sustained blunt multisystem injuries. Only 6.8% sustained penetrating injuries.
North East13%
Midwest34%
South28%
West25%
100%
20.2%
6.8%
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
All patients Blunt multisystem Penetrating
Patient Count
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Patient Characteristics
Figure 7. Age
The mean age of TQIP patients was 50. Penetrating injuries were most common in younger age groups.
Figure 8. Gender
Males comprise 67% of all patients and predominate in each subset.
0.0
10.0
20.0
30.0
40.0
50.0
60.0
All patients Blunt multisystem Penetrating
Patients (%)
Age Category
16 – 25 26 – 54 55 – 64 >= 65
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
All patients Blunt multisystem Penetrating
Patients (%)
Male Female
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Patient Characteristics Table 1. Comorbid Conditions
All patients Blunt multisystem Penetrating
N % N % N %
All Patients 85,569 100.0 17,270 20.2 5,832 6.8
Alcoholism 8,597 10.0 1,839 10.6 531 9.1
Ascites within 30 days 67 0.1 16 0.1 5 0.1
Bleeding Disorder 3,941 4.6 525 3.0 41 0.7
Chemotherapy for cancer within 30 days 161 0.2 16 0.1 0 0.0
Congenital Anomalies 234 0.3 37 0.2 11 0.2
Congestive heart failure 2,677 3.1 287 1.7 19 0.3
Current smoker 11,838 13.8 2,447 14.2 910 15.6
Currently requiring or on dialysis 591 0.7 73 0.4 6 0.1
CVA/residual neurological deficit 1,897 2.2 205 1.2 17 0.3
Diabetes mellitus 9,334 10.9 1,391 8.1 127 2.2
Disseminated cancer 634 0.7 95 0.6 4 0.1
Do Not Resuscitate (DNR) status 0 0.0 0 0.0 0 0.0
Esophageal varices 83 0.1 13 0.1 3 0.1
Functionally dependent health status 879 1.0 88 0.5 8 0.1
History of angina within past 1 month 131 0.2 11 0.1 2 0.0
History of myocardial infarction within past 6 mos 1,024 1.2 123 0.7 5 0.1History of revascularization / amputation for PVD 94 0.1 14 0.1 1 0.0
Hypertension requiring medication 23,906 27.9 3,561 20.6 390 6.7
Impaired sensorium 6,418 7.5 965 5.6 236 4.0
Prematurity 2,366 2.8 3 0.0 0 0.0
Respiratory Disease 5,577 6.5 933 5.4 221 3.8
Steroid use 345 0.4 54 0.3 5 0.1
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Patient Characteristics
Figure 9. Transfer
Over one-third of TQIP patients were transferred from another facility to the reporting facility.
Figure 10. Initial ED/Hospital Arrival Systolic Blood Pressure
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
All patients Blunt multisystem Penetrating
Patients (%)
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
All Patients Blunt Multisystem Penetrating
Patients (%)
<=60 61‐90 91‐109 >=110
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Injury Characteristics
Table 2. Mechanism of Injury All patients Blunt multisystem Penetrating
Mechanism N % N % N %
Cut/pierce 2,490 2.9 0 0.0 2,490 42.7
Fall 33,290 38.9 3,241 18.8 0 0.0
Firearm 3,341 3.9 0 0.0 3,341 57.3
MVT Motorcyclist 6,573 7.7 2,346 13.6 0 0.0
MVT Occupant 21,389 25.0 7,693 44.5 0 0.0
MVT Pedestrian & Pedal 4,343 5.1 1,602 9.3 0 0.0
Struck by, Against 5,603 6.5 550 3.2 0 0.0
Other 8,540 10.0 1,838 10.6 1 0.0 Falls and MVT (motor-vehicle-traffic) related incidents were the most common mechanisms of injury. *Values are shown as column percent.
Figure 11. Injury Severity Score
The average ISS for all TQIP patients was 17.3. The mean ISS was 28.3 for the blunt multisystem subset, and 18.5 for penetrating. Almost 50% of TQIP patients had an injury severity score in the 9 – 15 category. The blunt multisystem category has the highest proportion of patients with ISS>24.
0
10
20
30
40
50
60
70
All patients Blunt multisystem Penetrating
Patients (%)
9 – 15 16 – 24 >24
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Injury Characteristics
Figure 12. Severe Injuries (AIS>=3) By Body Region
Overall, head and chest injuries were the most common. Injuries from penetrating trauma predominantly affected the chest and abdomen.
Figure 13. GCS Motor Score
Most patients either localized or followed commands (GCS motor 5-6).
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Patients (%)
Body RegionAll patients Blunt multisystem Penetrating
0
10
20
30
40
50
60
70
80
90
All patients Blunt multisystem Penetrating
Patients (%)
1‐2 3‐4 5‐6
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Outcomes Note that TQIP follows patients only to the point of discharge from the ED or hospital. Post discharge outcomes are not available.
Table 3. Hospital Incidents All patients Blunt multisystem Penetrating
N % N % N %
All Patients 85,569 100.0 17,270 100.0 5,832 100.0
Abdominal compartment syndrome 222 0.3 127 0.7 30 0.5
Abdominal fascia left open 327 0.4 179 1.0 98 1.7
Acute renal failure 1,118 1.3 400 2.3 127 2.2
Acute respiratory distress syndrome (ARDS) 1,727 2.0 860 5.0 143 2.5
Base deficit 2,986 3.5 1,399 8.1 384 6.6
Bleeding 1,242 1.5 659 3.8 239 4.1
Cardiac arrest with CPR 1,079 1.3 518 3.0 176 3.0
Coagulopathy 784 0.9 355 2.1 130 2.2
Coma 401 0.5 207 1.2 12 0.2
Decubitus ulcer 941 1.1 455 2.6 60 1.0
Deep surgical site infection 200 0.2 86 0.5 49 0.8
Drug or alcohol withdrawal syndrome 1,030 1.2 254 1.5 45 0.8
Deep Vein Thrombosis (DVT) / thrombophlebitis 1,543 1.8 746 4.3 107 1.8
Extremity compartment syndrome 268 0.3 101 0.6 28 0.5
Graft/prosthesis/flap failure 39 0.0 10 0.1 3 0.1
Myocardial infarction 333 0.4 87 0.5 14 0.2
Organ/space surgical site infection 335 0.4 120 0.7 93 1.6
Pneumonia 4,163 4.9 1,921 11.1 267 4.6
Pneumonia (intubated)* 3,225 25.2 1,656 28.1 197 17.4
Pulmonary embolism 610 0.7 259 1.5 50 0.9
Stroke / CVA 270 0.3 117 0.7 10 0.2
Superficial surgical site infection 349 0.4 139 0.8 91 1.6
Systemic sepsis 1,140 1.3 558 3.2 155 2.7
Unplanned intubation 1,297 1.5 489 2.8 139 2.4
Wound disruption 203 0.2 86 0.5 67 1.1
*Intubated is defined as patients with ventilator days > 1, and the percentages for this row are calculated based on the patients that met the definition for intubation: 12,822 patients total with ventilator days >1; 5,896 blunt multisystem patients; and 1,134 penetrating patients.
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Outcomes
Table 4. Mortality
All patients Blunt
multisystem Penetrating Overall mortality 7.1 13.9 16.5 ED mortality 1.8 3.3 9.6 In-hospital mortality 5.3 10.6 6.9
Overall mortality for TQIP patients was 7%. Patients with penetrating injuries have the highest mortality. Most of these patients died in the ED.
Figure 14. Length of Stay
Overall mean length of stay for all TQIP patients is eight days (median is 5 days). Patients with blunt multisystem injuries had the longest length of stay.
0
2
4
6
8
10
12
14
All patients Blunt multisystem Penetrating
LOS (days)
Median Mean
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Outcomes
Figure 15. ICU Length of Stay
Among patients with an ICU stay, the mean ICU length of stay was six days (median was three days). Patients with blunt multisystem injuries had the longest lengths of stay in the ICU.
Figure 16. Ventilator Days
Among patients with an ICU stay and who were on the ventilator, the mean number of days on the ventilator was over 7 days (median was 4 days). Patients with blunt multisystem injuries had the highest number of ventilator days.
0
1
2
3
4
5
6
7
8
9
All patients Blunt multisystem Penetrating
ICU LOS (days)*
Median Mean
0
1
2
3
4
5
6
7
8
9
10
All patients Blunt multisystem Penetrating
Ventilator (days)
Median Mean
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Inter-Hospital Comparisons Patient characteristics and injury severity differ across trauma centers. These differences may affect the risk profile of patients at one center compared to another. Therefore, comparing crude mortality rates across centers is not a valid method for making inter-hospital comparisons. To account for these differences, statistical models were developed to estimate the outcomes of mortality and length of stay for each hospital based on patient characteristics (see Appendix C). Data Quality Missing Data Missing data has significant implications for inter-facility comparisons. Of the 85,569 2010 admissions that met TQIP inclusions criteria, 4% had missing data in fields that might affect our ability to risk-adjust. The distribution of missing values for the covariates ranged from 0 to 4%. Records with missing data are not excluded from analyses. Rather, we use multiple imputation to provide the best estimates of what the true values might be. By design, all deaths were excluded from the LOS analysis. In addition, 1,427 (0.5%) records with a missing length of stay were also excluded. Payment status (insurance status) was missing in a small number of centers. Rather than impute the missing payment status, we used a “missing” category in the risk adjustment models, while all other missing variables were imputed. Injury Severity AIS is not currently required by NTDB. Not all centers contribute the full AIS score to NTDB. Moreover, those that do provide AIS use a variety of versions and coding methods. To overcome these variations, we convert all submitted AIS to AIS 98 as follows: • AIS 05 is crosswalked to AIS 98 based on AAAM AIS 05 Manual • AIS 90 or 95 is crosswalked to AIS 98 • ICD-90 Map is used if no AIS is submitted (to convert ICD-9 codes to AIS)
Limitations of Interfacility Comparisons The ACS TQIP report allows centers to compare their outcomes with other hospitals. However, it is possible that factors other than quality of care may influence the risk-adjusted mortality rates. The following limitations must be kept in mind when interpreting your data:
• Data quality: It is possible that differences in data quality, such as capture of complications or coding of injury diagnosis, might contribute to any observed differences in O/E mortality ratios or complication rates. For example, if patients are identified as not having complications yet had experienced significant complications that prolonged their length of stay; these patients would be identified as those with excess LOS.
• Performance over time: A trauma center’s performance may vary over time. The current report presents a single snapshot in time.
• Chance: Statistical models are simply estimates. It is possible that chance alone led to the position of your center’s performance relative to its peers. However, the likelihood of this occurrence by chance alone is less than 10% (based on 90% confidence intervals).
• In hospital outcomes: O/E mortality ratios are based upon in-hospital mortality. Differences in discharge disposition or access to alternate levels of care might influence in-hospital mortality rates.
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Risk Adjusted Mortality
Multivariate logistic regression models were used to estimate expected number of deaths for each hospital based on patient characteristics. For each trauma center, the observed mortality rate was then divided by the expected mortality rate to obtain the Observed-to-Expected (O/E) ratio with their 95% confidence intervals. O/E ratios were plotted on a chart in increasing order. The large number of centers make interpretation of the graphs challenging. To overcome this issue, we present graphs for odd and even numbered centers separately. Model performance was evaluated with the C-statistic and calibration curve (Appendix C). We acknowledge there are differences in the way DOA (dead on arrival) and DIE (died in the emergency department) patients are captured across institutions. We also acknowledge that the proportion of patients DOA or DIE will be higher for inner city trauma centers than suburban centers due to shorter transport times. Other system factors might also play a role in the proportion of deaths that might be considered DOA, DIE or in-hospital. To overcome this variation we have produced O/E ratios both including and excluding all deaths in the emergency department (DIE and DOA). Interpretation of the caterpillar graphs and O/E ratio • Refer to the TQIP report ID that we have provided to you this year. If you do not know your TQIP report ID,
then please contact us at [email protected]. • Find your own center on the caterpillar graphs using your TQIP report ID. • Is the confidence interval for your facility completely above the line?
o If yes, then your facility has more deaths than expected based on the risk adjustment model • Is the confidence interval for your facility completely below the line?
o If yes, then your facility has fewer deaths than expected based on the risk adjustment model • If the confidence interval for your facility touching the line?
o If yes, then your facility had the expected number of deaths based on the risk adjustment model Please note that centers with less than 10 patients in a particular subgroup are not shown on the following graphs, yet are included in the risk adjustment models.
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Table 5. Unadjusted Mortality, Including Patients Classified as DOA or Died in the ED
TQIP Report ID
All patients Blunt multisystem Penetrating
N % N % N %
All 6,077 7.1 2,397 13.9 962 16.5
1 3 1.5 0 0 1 6.7
2 87 7.0 39 18.8 13 14.1
3 32 4.1 11 6.7 5 8.3
4 42 6.1 18 11.4 4 15.4
5 24 5.1 7 9.6 2 7.7
6 45 7.5 15 17.6 8 8.1
7 13 4.5 7 16.3 1 20.0
8 27 8.3 9 15.5 5 12.5
9 35 8.9 22 21.4 12 19.7
10 17 4.6 8 10.1 3 25.0
11 64 9.3 22 22.7 7 23.3
12 94 6.5 30 11.1 17 25.0
13 58 6.6 29 12.2 6 14.0
14 29 7.7 9 16.4 1 2.2
15 27 5.5 5 6.2 1 33.3
16 13 3.5 4 7.3 2 11.1
17 31 6.4 11 17.5 4 28.6
18 25 7.2 6 11.8 2 22.2
19 6 3.2 1 12.5 0 0
20 29 4.7 15 14.4 0 0
21 147 6.7 74 12.7 14 16.9
22 41 6.2 8 7.5 11 31.4
23 41 8.7 15 14.2 14 19.2
24 41 6.9 15 16.9 0 0
25 231 8.2 105 13.3 55 17.7
26 60 8.3 20 14.3 7 14.6
27 68 6.0 29 11.2 5 12.8
28 21 4.9 7 16.7 0 0
29 35 5.6 26 14.8 0 0
30 12 4.7 6 22.2 0 0
31 10 4.9 2 11.1 2 14.3
32 74 9.3 34 21.4 3 5.4
33 33 5.1 15 12.1 1 7.7
34 22 10.4 7 21.2 10 26.3
35 88 7.3 23 11.9 32 22.9
36 43 8.6 23 27.7 3 9.7
37 131 11.4 68 22.8 29 25.2
38 44 6.1 10 8.9 7 25.9
39 60 7.4 19 10.5 12 15.6
40 50 7.3 18 20.0 8 21.6
41 106 7.9 49 15.8 10 15.2
42 141 7.1 38 9.1 17 11.1
43 64 9.3 22 19.5 8 22.2
44 53 9.0 14 18.9 1 5.0
45 121 7.7 52 13.9 25 15.5
46 55 7.4 12 9.9 5 15.6
47 73 5.1 26 9.2 6 16.2
48 81 9.0 34 14.0 11 14.9
49 32 6.3 10 13.0 8 15.1
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TQIP Report ID
All patients Blunt multisystem Penetrating
N % N % N %
50 25 5.2 14 13.9 4 17.4
51 87 6.8 44 14.7 8 11.8
52 205 7.7 109 14.7 22 12.1
53 65 9.4 38 25.5 5 16.1
54 128 9.7 49 19.4 43 34.7
55 43 6.2 15 10.7 3 10.3
56 38 5.7 11 10.7 2 9.5
57 44 5.2 25 13.3 1 3.6
58 19 3.7 8 7.0 0 0
59 93 7.4 34 11.3 23 18.7
60 46 6.0 24 14.0 1 6.3
61 88 6.9 37 17.6 3 7.0
62 48 6.8 14 14.3 5 8.9
63 44 3.2 21 8.1 5 16.1
64 46 5.0 19 10.4 3 13.6
65 81 11.8 45 16.9 8 12.3
66 24 5.0 9 17.6 2 20.0
67 38 7.9 10 13.2 5 14.3
68 26 8.0 4 7.8 9 22.0
69 162 11.1 62 17.6 61 23.2
70 22 6.9 6 15.0 3 14.3
71 14 3.5 6 10.2 0 0
72 79 7.6 44 19.4 4 14.3
73 26 7.0 7 14.0 6 12.8
74 71 6.7 31 15.3 11 22.9
75 62 7.1 19 10.7 4 7.8
76 55 5.9 9 4.2 31 19.3
77 31 5.4 14 15.7 0 0
78 12 4.4 6 9.4 0 0
79 31 6.6 9 10.1 5 27.8
80 46 6.2 17 9.7 3 14.3
81 95 8.1 37 15.8 8 9.6
82 60 6.0 22 20.6 5 9.3
83 94 11.0 44 25.9 10 23.3
84 51 6.8 14 9.8 1 6.3
85 31 7.6 12 24.5 1 14.3
86 72 10.3 15 21.1 30 30.6
88 77 7.9 21 9.3 17 16.0
89 108 6.6 55 11.9 7 10.4
90 34 6.8 13 8.4 7 25.0
91 14 4.5 3 7.0 0 0
92 52 6.5 22 15.0 4 10.3
93 36 11.8 15 19.0 9 25.0
94 73 11.2 21 19.3 26 17.9
95 69 7.9 34 18.5 11 16.7
96 70 10.0 16 13.8 31 17.5
97 24 3.2 6 10.0 0 0
98 102 6.8 42 13.0 12 10.1
99 9 4.6 4 12.5 1 5.6
100 22 8.3 9 19.6 1 33.3
101 26 5.8 14 13.6 6 16.2
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TQIP Report ID
All patients Blunt multisystem Penetrating
N % N % N %
102 31 7.4 13 14.8 4 20.0
103 33 5.8 15 11.4 1 3.7
104 30 4.1 8 7.6 5 7.7
105 53 10.3 23 22.1 20 21.1
106 35 4.4 11 9.9 4 11.1
107 36 4.1 11 6.1 0 0
108 67 16.5 16 33.3 42 30.2
109 51 9.9 14 19.7 4 14.8
110 34 6.3 10 14.5 6 8.2
111 14 4.3 4 7.4 2 28.6
112 29 6.5 10 10.4 7 16.7
113 13 5.9 6 15.4 0 0
114 54 8.5 28 14.9 2 14.3
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Table 6. Unadjusted Mortality, Excluding Patients Classified as DOA or Died in the ED
TQIP Report ID All Patients Blunt multisystem Penetrating
N % N % N %
ALL 4,530 5.4 1,829 11.0 404 7.7
1 3 1.5 0 0 1 6.7
2 53 4.4 19 10.2 4 4.8
3 30 3.9 10 6.1 5 8.3
4 33 4.8 12 7.9 2 8.3
5 21 4.5 7 9.6 0 0
6 30 5.1 7 9.1 2 2.2
7 9 3.1 5 12.2 0 0
8 20 6.3 8 14.0 2 5.4
9 18 4.8 15 15.6 3 5.8
10 10 2.7 5 6.6 0 0
11 52 7.7 17 18.5 2 8.0
12 73 5.1 26 9.7 4 7.3
13 51 5.9 28 11.9 3 7.5
14 19 5.2 5 9.8 1 2.2
15 22 4.6 4 5.0 1 33.3
16 8 2.2 1 1.9 1 5.9
17 24 5.1 8 13.3 3 23.1
18 23 6.6 5 10.0 1 12.5
19 5 2.6 1 12.5 0 0
20 26 4.3 13 12.7 0 0
21 107 5.0 51 9.1 7 9.2
22 30 4.6 6 5.7 6 20.0
23 21 4.7 11 10.8 3 4.8
24 34 5.8 12 14.0 0 0
25 146 5.3 68 9.0 15 5.5
26 59 8.2 19 13.7 7 14.6
27 56 5.0 26 10.2 4 10.5
28 18 4.2 5 12.5 0 0
29 27 4.4 18 10.7 0 0
30 8 3.2 3 12.5 0 0
31 7 3.4 2 11.1 0 0
32 62 7.9 29 18.8 0 0
33 30 4.7 13 10.7 1 7.7
34 13 6.4 5 16.1 3 9.7
35 52 4.5 15 8.1 10 8.5
36 31 6.3 16 21.1 1 3.4
37 74 6.8 38 14.2 14 14.0
38 38 5.3 10 8.9 3 13.0
39 39 4.9 11 6.4 4 5.8
40 34 5.1 14 16.3 3 9.4
41 85 6.4 40 13.3 5 8.2
42 123 6.3 36 8.7 11 7.5
43 52 7.7 16 15.0 4 12.5
44 48 8.2 12 16.7 1 5.0
45 86 5.6 41 11.3 7 4.9
46 46 6.3 9 7.6 3 10.0
47 68 4.8 24 8.5 5 13.9
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TQIP Report ID All Patients Blunt multisystem Penetrating
N % N % N %
48 55 6.3 28 11.9 4 6.0
49 21 4.2 6 8.2 4 8.2
50 15 3.2 8 8.4 2 9.5
51 71 5.6 38 12.9 5 7.7
52 146 5.6 71 10.1 11 6.4
53 48 7.1 27 19.6 0 0
54 72 5.7 25 10.9 15 15.6
55 36 5.3 14 10.1 3 10.3
56 34 5.2 11 10.7 1 5.0
57 42 4.9 25 13.3 1 3.6
58 12 2.3 5 4.5 0 0
59 60 4.9 30 10.1 8 7.4
60 39 5.2 20 12.0 0 0
61 81 6.4 34 16.4 3 7.0
62 45 6.4 13 13.4 5 8.9
63 43 3.1 21 8.1 5 16.1
64 39 4.3 18 9.9 2 9.5
65 69 10.2 41 15.6 3 5.0
66 18 3.8 6 12.5 0 0
67 29 6.1 9 12.0 4 11.8
68 22 6.8 4 7.8 7 17.9
69 98 7.0 48 14.2 17 7.8
70 18 5.7 5 12.8 2 10.0
71 11 2.8 3 5.4 0 0
72 58 5.7 28 13.3 2 7.7
73 23 6.3 6 12.2 5 10.9
74 50 4.8 25 12.8 4 9.8
75 48 5.6 17 9.7 3 6.0
76 33 3.6 9 4.2 11 7.8
77 26 4.5 11 12.8 0 0
78 7 2.6 2 3.3 0 0
79 25 5.4 7 8.0 2 13.3
80 43 5.8 17 9.7 2 10.0
81 82 7.1 34 14.7 6 7.4
82 42 4.2 12 12.4 2 3.9
83 76 9.0 32 20.3 6 15.4
84 43 5.8 13 9.2 0 0
85 22 5.5 6 14.0 1 14.3
86 34 5.2 9 13.8 8 10.5
88 53 5.6 16 7.2 8 8.2
89 82 5.1 43 9.6 5 7.7
90 27 5.5 10 6.6 5 19.2
91 13 4.2 2 4.8 0 0
92 41 5.2 18 12.6 1 2.8
93 27 9.2 13 16.9 5 15.6
94 39 6.3 13 12.9 4 3.3
95 32 3.8 19 11.2 1 1.8
96 47 6.9 14 12.3 19 11.5
97 24 3.2 6 10.0 0 0
98 96 6.4 41 12.7 10 8.5
99 9 4.6 4 12.5 1 5.6
20
TQIP Report ID All Patients Blunt multisystem Penetrating
N % N % N %
100 14 5.4 5 11.9 1 33.3
101 12 2.7 7 7.3 1 3.1
102 23 5.6 10 11.8 2 11.1
103 33 5.8 15 11.4 1 3.7
104 30 4.1 8 7.6 5 7.7
105 26 5.3 14 14.7 4 5.1
106 28 3.6 9 8.3 2 5.9
107 33 3.7 11 6.1 0 0
108 24 6.6 9 22.0 11 10.2
109 40 8.0 14 19.7 2 8.0
110 27 5.1 7 10.6 5 6.9
111 10 3.1 2 3.8 1 16.7
112 20 4.6 6 6.5 3 7.9
113 11 5.1 4 10.8 0 0
114 49 7.8 25 13.5 1 7.7
21
Figure 17a. Risk Adjusted Mortality – All patients including DIE/DOA (odd numbered IDs)
22
Figure 17b. Risk Adjusted Mortality – All patients including DIE/DOA (even numbered IDs)
23
Figure 18a. Risk Adjusted Mortality – All patients excluding DIE/DOA (odd numbered IDs)
O/E
rat
io w
ith
95%
CI
0.0
0.5
1.0
1.5
2.0
2.5
3.0
TQIP Report ID
19
7 107
29
95
1 97
71
111
113
17
15
21
63
3 33
9 49
57
59
55
79
101
91
5 13
45
39
47
99
61
35
85
83
27
69
89
75
43
31
37
51
25
105
67
103
77
93
81
53
65
23
109
41
73
11
Risk Adjusted Mortality: All PatientsExcluding those classified as DOA or died in the ED
24
Figure 18b. Risk Adjusted Mortality – All patients excluding DIE/DOA (even numbered IDs)
O/E
rat
io w
ith
95%
CI
0.0
0.5
1.0
1.5
2.0
TQIP Report ID
16
10
106
58
50
76
104
2 22
20
6 78
80
74
64
12
60
28
52
66
4 70
82
46
42
112
38
36
30
32
88
114
14
34
100
92
90
48
54
8 56
40
24
102
110
108
86
84
18
44
98
72
26
68
94
96
62
Risk Adjusted Mortality: All PatientsExcluding those classified as DOA or died in the ED
25
Figure 19a. Risk Adjusted Mortality – Blunt multisystem including DIE/DOA (odd numbered IDs)
* Centers with estimated O/E ratios of zero.
26
Figure 19b. Risk Adjusted Mortality – Blunt multisystem including DIE/DOA (even numbered IDs)
27
Figure 20a. Risk Adjusted Mortality – Blunt multisystem excluding DIE/DOA (odd numbered IDs)
* Centers with estimated O/E ratios of zero.
O/E
rat
io w
ith
95%
CI
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
TQIP Report ID
1 15
111
91
71
107
79
39
3 49
29
7 5 33
95
35
97
59
21
75
47
55
13
69
63
57
113
9 89
27
83
103
17
61
51
31
85
45
25
43
101
37
93
99
23
81
67
65
53
109
77
105
41
11
73
***
Risk Adjusted Mortality: Blunt Multisystem InjuriesExcluding those classified as DOA or died in the ED
28
Figure 20b. Risk Adjusted Mortality – Blunt multisystem excluding DIE/DOA (even numbered IDs)
O/E
rat
io w
ith
95%
CI
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
TQIP Report ID
16
76
22
6 78
106
10
112
50
80
42
2 58
46
90
38
88
12
64
104
52
14
70
66
48
60
18
4 114
56
74
20
110
68
84
28
100
54
102
26
92
24
98
32
86
36
96
44
40
72
8 34
82
62
94
30
108
Risk Adjusted Mortality: Blunt Multisystem InjuriesExcluding those classified as DOA or died in the ED
29
Figure 21a. Risk Adjusted Mortality – Penetrating including DIE/DOA (odd numbered IDs)
* Centers with estimated O/E ratios of zero.
O/E
rat
io w
ith
95%
CI
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
TQIP Report ID
71
107
113
61
5 95
3 53
13
89
49
1 21
65
25
37
55
101
31
57
83
45
73
59
69
9 51
105
109
35
23
39
63
93
67
47
81
41
75
43
17
27
11
79
103
99
33
******
***
Risk Adjusted Mortality: Penetrating InjuriesIncluding those classified as DOA or died in the ED
30
Figure 21b. Risk Adjusted Mortality – Penetrating Including DIE/DOA (even numbered IDs)
O/E
rat
io w
ith
95%
CI
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
TQIP Report ID
20
104
60
10
14
56
84
6 36
52
114
92
94
46
8 34
40
72
26
110
88
2 12
48
32
76
70
54
106
108
86
42
112
68
38
74
82
102
4 98
64
22
16
96
62
50
66
90
44
80
***
Risk Adjusted Mortality: Penetrating InjuriesIncluding those classified as DOA or died in the ED
31
Figure 22a. Risk Adjusted Mortality – Penetrating excluding DIE/DOA (odd numbered IDs)
* Centers with estimated O/E ratios of zero.
O/E
rat
io w
ith
95%
CI
0.00.51.01.52.02.53.03.54.04.55.05.56.06.57.07.58.08.59.09.5
10.010.511.0
TQIP Report ID
5 31
53
71
107
113
95
61
21
49
25
101
3 13
89
65
45
37
105
57
1 83
73
69
59
55
35
39
51
9 41
109
81
63
93
47
43
23
75
67
17
11
103
27
99
79
33
***
***
***
******
***
Risk Adjusted Mortality: Penetrating InjuriesExcluding those classified as DOA or died in the ED
32
Figure 22b. Risk Adjusted Mortality – Penetrating excluding DIE/DOA (even numbered IDs)
O/E
rat
io w
ith
95%
CI
0.00.51.01.52.02.53.03.54.04.55.05.56.06.57.07.58.08.59.09.5
10.010.511.0
TQIP Report ID
20
32
60
84
104
6 94
56
92
36
14
114
52
46
34
8 2 72
102
76
40
12
88
112
42
48
26
110
38
108
70
50
82
54
68
74
98
106
4 86
22
44
64
96
62
90
16
80
***
*** ***
***
Risk Adjusted Mortality: Penetrating InjuriesExcluding those classified as DOA or died in the ED
33
Risk Adjusted Length of Stay
All TQIP patients with a known length of stay (LOS) who did not have an ED or hospital discharge status of died were included in this analysis. A predicted length of stay for each patient was estimated. If a patient remained in hospital more than 25% longer than their predicted LOS, they were considered to have an excess LOS (ELOS). Table 7 shows the mean and median LOS for each trauma center, for all patients and subsets. The proportion of patients in each center with an ELOS was compared to the average proportion of patients with an ELOS at all centers and presented on a caterpillar graph. If the confidence interval for the proportion of cases with ELOS includes the average proportion of ELOS, then the center has equivalent performance to the average center (proportion of ELOS of 17.9). We use confidence intervals ranging from 90 to 99%, depending on the sample size for each of the subgroups. Results are presented for all TQIP patients, the two subsets, and for the following two populations with isolated injuries: • Thoracic injury – pneumothorax, not further specified: AIS code - 442202 • Midshaft femur fracture: AIS code - 851814
Table 7 shows the unadjusted length of stay by center, and Table 8 shows the proportion of patients with ELOS. To interpret the ELOS: • Refer to the TQIP report ID that we have provided to you this year. If you do not know your TQIP report ID,
then please contact us at [email protected]. • If the lower limit of your confidence interval is above the average proportion of ELOS, then your center has
more patients with ELOS than expected. • If the upper limit of your confidence interval is below the average proportion of ELOS, then your center has
fewer patients with ELOS than expected. • If the average proportion of ELOS falls within your confidence interval, then your center’s performance is
equivalent to the average center.
34
Table 7. Unadjusted Length of Stay (days) These data calculated from patients whose LOS is known and excluding patients who died
All patients Blunt multisystem Penetrating Isolated pneumothorax
Isolated mid-shaft femur fracture
N Mean Median N Mean Median N Mean Median N Mean Median N Mean Median
All Patients 79434 8.1 5.0 14868 13.9 9.0 4870 10.3 6.0 6380 6.9 5.0 2420 7.3 5.0
TQIP Report ID
198 8.5 5.0 15 21.9 17.0 14 9.7 4.5 11 10.4 8.0 4 5.8 6.0 1
2 1154 7.1 5.0 168 12.0 9.0 79 9.0 7.0 90 5.5 4.0 27 5.3 6.0
3 743 7.5 4.0 153 12.0 7.0 55 7.5 5.0 10 4.6 3.0 18 7.3 6.5
4 644 6.2 4.0 140 10.0 7.0 22 6.5 5.5 68 4.4 3.0 16 6.4 4.5
5 443 8.4 5.0 66 15.2 11.5 24 8.3 6.5 33 8.3 6.0 10 10.3 9.5
6 556 9.7 6.0 70 19.3 11.0 91 9.4 6.0 51 8.5 4.0 11 6.6 4.0
7 279 4.8 3.0 36 12.6 7.0 4 5.3 5.5 7 3.9 4.0 5 4.0 5.0
8 300 9.8 5.5 49 17.6 10.0 35 8.3 5.0 21 9.8 6.0 6 4.7 5.0
9 357 8.4 4.0 81 19.3 8.0 49 7.3 5.0 30 5.2 3.0 8 5.8 5.0
10 356 5.8 4.0 71 8.9 7.0 9 9.2 5.0 28 7.5 4.0 11 4.5 5.0
11 624 9.8 6.0 75 18.4 11.0 23 11.3 7.0 23 3.4 3.0 30 13.4 8.0
12 1357 7.7 5.0 241 14.2 9.0 51 15.0 9.0 78 5.7 4.0 29 6.2 5.0
13 820 8.8 6.0 208 13.9 10.0 37 9.5 8.0 75 7.9 6.0 34 8.0 6.0
14 347 8.8 6.0 46 11.8 9.0 45 11.8 9.0 19 7.5 6.0 8 9.9 7.5
15 460 8.5 6.0 76 17.1 15.0 2 6.5 6.5 33 10.5 6.0 15 9.9 7.0
16 356 7.5 5.0 51 13.6 9.0 16 11.0 6.0 31 6.2 4.0 8 6.5 6.5
17 450 10.4 6.0 52 21.7 16.0 10 12.6 10.0 21 6.3 5.0 25 8.9 6.0
18 323 6.3 5.0 45 12.0 9.0 7 6.9 6.0 18 8.8 5.0 11 4.7 5.0
19 184 5.0 4.0 7 8.3 9.0 0 0 0 17 4.2 4.0 11 6.1 5.0
20 583 7.3 5.0 89 12.3 9.0 11 12.8 7.0 60 7.1 5.0 19 8.9 7.0
21 2052 7.3 5.0 510 11.3 7.5 69 10.8 7.0 160 5.5 4.0 35 6.1 5.0
22 617 7.5 5.0 99 12.3 9.0 24 7.7 5.0 54 7.7 5.5 43 6.6 5.0
23 428 9.1 5.0 91 14.4 10.0 59 7.5 4.0 24 4.9 3.5 6 14.7 12.0
24 552 10.1 5.0 74 20.9 13.5 8 6.4 5.0 79 9.0 5.0 16 6.6 5.0
25 2593 6.8 4.0 684 10.1 6.0 256 9.1 6.0 175 6.5 3.0 70 7.0 5.0
26 662 7.0 4.0 120 12.2 9.0 41 7.6 6.0 52 5.8 5.5 12 5.3 5.0
27 1070 7.2 5.0 229 12.0 8.0 34 8.0 5.5 13 4.8 3.0 27 6.1 5.0
28 366 4.2 1.0 30 7.5 6.0 5 4.4 6.0 4 1.0 1.0 11 5.7 1.0
29 593 8.6 6.0 150 14.9 12.0 9 17.6 15.0 34 4.9 4.0 12 8.2 5.0
30 241 5.5 5.0 21 9.3 6.0 1 4.0 4.0 28 6.2 6.5 15 4.4 5.0
35
All patients Blunt multisystem Penetrating Isolated pneumothorax
Isolated mid-shaft femur fracture
N Mean Median N Mean Median N Mean Median N Mean Median N Mean Median
31 196 5.1 4.0 16 10.9 6.0 12 4.8 4.5 17 5.4 3.0 8 3.9 4.0
32 717 8.3 5.0 125 13.3 10.0 53 7.8 5.0 53 7.3 5.0 26 9.0 5.0
33 613 7.8 5.0 109 14.7 11.0 12 15.0 4.0 68 6.4 4.0 21 8.4 4.0
34 189 7.4 5.0 26 7.7 6.0 28 11.6 6.5 13 4.3 4.0 7 9.1 6.0
35 1112 8.4 5.0 171 13.7 9.0 108 10.9 7.0 46 6.7 5.5 34 7.1 5.0
36 459 7.8 5.0 60 16.1 11.0 28 6.6 5.0 49 5.8 5.0 19 5.9 5.0
37 1015 10.5 5.0 230 18.0 10.0 86 15.2 7.5 143 8.0 4.0 33 9.2 6.0
38 676 8.8 5.0 102 18.1 11.5 20 13.9 10.5 20 4.3 3.0 6 10.8 10.5
39 755 9.2 6.0 162 14.5 10.5 65 8.5 5.0 73 7.5 5.0 24 7.3 5.5
40 634 7.4 5.0 72 13.2 9.0 29 8.1 8.0 64 6.6 4.0 34 5.9 5.0
41 1243 9.6 6.0 261 15.2 9.0 56 10.4 7.5 157 9.1 6.0 48 9.4 7.0
42 1836 9.0 5.0 380 15.9 11.0 136 11.0 8.0 122 7.7 5.0 84 6.5 5.0
43 625 6.0 4.0 91 10.3 7.0 28 7.2 5.0 72 6.2 4.0 17 5.5 4.0
44 537 9.1 6.0 60 16.4 14.0 19 13.2 10.0 50 10.5 7.0 16 7.4 6.0
45 1453 6.5 4.0 321 9.9 8.0 136 8.1 6.0 158 5.3 4.0 52 6.8 5.0
46 689 6.1 4.0 109 11.1 7.0 27 8.6 7.0 44 5.9 4.0 30 5.6 4.0
47 1353 6.5 4.0 258 11.1 8.0 31 10.4 6.0 103 5.0 4.0 29 6.1 4.0
48 817 10.2 5.0 208 17.7 10.0 63 11.1 7.0 58 9.6 6.0 33 6.0 5.0
49 476 9.1 6.0 67 18.4 11.0 45 11.4 6.0 40 8.9 5.5 20 5.7 4.0
50 453 8.3 5.0 87 16.5 10.0 19 6.8 6.0 25 6.6 4.0 6 6.2 6.0
51 1190 8.1 5.0 256 13.9 11.0 60 10.4 5.0 41 4.7 3.0 30 7.9 5.5
52 2442 10.5 7.0 631 16.1 12.0 160 13.2 9.0 157 9.8 7.0 87 9.4 8.0
53 626 8.1 5.0 111 14.5 12.0 26 9.8 6.5 40 8.1 4.0 7 5.4 5.0
54 1194 8.0 5.0 204 13.2 9.0 81 9.7 7.0 90 5.9 4.0 28 6.0 5.0
55 647 9.4 6.0 125 15.6 12.0 26 12.5 11.5 53 10.5 8.0 26 5.7 5.5
56 624 6.7 5.0 92 10.6 8.5 19 9.5 5.0 23 6.0 4.0 30 7.1 6.0
57 809 6.5 5.0 163 10.3 8.0 27 8.0 6.0 70 6.2 5.0 28 5.1 4.5
58 499 7.6 5.0 107 13.5 9.0 3 3.0 3.0 44 6.2 4.5 13 5.3 5.0
59 1159 8.3 5.0 267 13.9 9.0 100 9.5 6.0 127 5.6 4.0 27 7.0 5.0
60 718 9.1 6.0 147 15.5 10.0 15 14.6 7.0 82 8.0 6.0 22 5.3 5.0
61 1179 7.5 5.0 173 13.8 9.0 40 11.3 4.0 131 5.5 4.0 39 7.3 5.0
62 654 7.9 5.0 84 13.7 9.0 51 6.8 4.0 67 8.8 6.0 31 10.4 8.0
63 1325 6.9 4.0 239 11.6 9.0 26 12.5 9.5 12 5.7 3.5 36 7.2 6.0
64 876 7.1 5.0 164 12.6 9.0 19 9.1 7.0 90 5.7 5.0 27 6.8 5.0
65 608 12.3 7.0 222 16.0 10.0 57 8.3 5.0 8 10.5 5.5 6 7.7 6.0
36
All patients Blunt multisystem Penetrating Isolated pneumothorax
Isolated mid-shaft femur fracture
N Mean Median N Mean Median N Mean Median N Mean Median N Mean Median
66 454 6.5 5.0 42 11.8 7.5 8 8.8 7.5 43 4.8 4.0 22 5.5 5.0
67 446 10.1 6.0 66 20.2 12.5 30 11.8 6.0 23 9.7 6.0 20 7.8 5.0
68 301 8.5 6.0 47 14.4 9.0 32 12.9 6.5 24 6.8 6.5 11 6.1 4.0
69 1302 13.8 7.0 290 21.1 12.5 202 18.4 10.0 84 12.0 8.0 46 10.8 8.0
70 296 6.9 4.5 34 14.5 11.0 18 8.7 6.0 39 6.9 5.0 9 8.1 7.0
71 386 7.3 5.0 53 14.4 11.0 10 10.3 9.0 50 7.7 6.0 12 6.3 4.0
72 958 6.3 4.0 183 10.4 7.0 24 7.7 5.0 18 4.4 4.5 28 5.7 5.0
73 343 6.2 4.0 43 9.4 5.0 41 9.1 8.0 37 5.3 4.0 17 6.8 4.0
74 992 7.7 5.0 171 12.7 9.0 37 11.3 6.0 109 6.2 4.0 22 6.9 5.0
75 811 9.6 6.0 159 18.6 11.0 47 10.4 7.0 73 7.8 5.0 43 7.1 5.0
76 874 9.8 7.0 205 15.1 11.0 130 11.9 9.5 52 6.5 4.5 21 7.4 7.0
77 547 6.6 4.0 75 13.2 9.0 6 15.8 6.0 14 6.9 6.0 6 5.7 5.0
78 260 6.9 5.0 58 10.5 9.0 8 3.8 4.0 27 8.0 5.0 8 4.6 5.0
79 440 5.7 4.0 80 10.6 8.0 13 5.1 5.0 39 5.1 4.0 16 5.2 5.0
80 694 9.5 5.0 159 16.8 11.0 18 8.2 5.0 44 8.0 6.0 31 8.0 8.0
81 1071 9.1 6.0 197 14.9 9.0 75 9.3 6.0 124 8.0 4.0 36 9.0 6.0
82 947 6.1 4.0 85 12.2 8.0 49 6.1 5.0 115 5.4 4.0 19 6.7 5.0
83 764 7.5 5.0 126 13.9 11.0 33 9.9 7.0 68 7.3 5.0 26 5.8 5.0
84 699 5.5 4.0 129 7.7 6.0 15 5.6 3.0 44 5.3 4.0 21 6.2 4.0
85 378 7.3 5.0 37 15.6 7.0 6 9.5 7.0 28 6.6 5.5 14 4.8 4.5
86 626 8.7 6.0 56 14.6 11.0 68 9.7 6.5 67 8.5 5.0 38 8.4 7.0
88 895 10.8 6.0 205 17.1 13.0 89 11.5 7.0 71 10.6 6.0 28 7.9 6.0
89 1538 8.5 5.0 407 14.3 10.0 60 8.7 5.5 194 6.2 4.0 57 10.5 7.0
90 463 12.4 8.0 142 20.6 14.0 21 11.5 11.0 40 8.4 6.0 8 7.3 7.5
91 300 6.2 4.0 40 11.3 8.5 2 7.0 7.0 26 6.2 5.0 4 6.3 4.0
92 749 6.4 4.0 125 9.7 7.0 35 10.6 5.0 89 5.7 4.0 25 5.8 6.0
93 268 11.5 8.0 64 15.8 12.0 27 9.6 7.0 32 8.8 5.0 10 9.4 9.0
94 581 8.1 5.0 88 18.4 9.0 119 8.1 5.0 58 5.8 3.5 13 5.7 6.0
95 806 7.2 5.0 150 11.8 9.0 55 10.2 7.0 91 5.4 4.0 14 7.9 6.5
96 631 12.7 7.0 100 19.3 16.0 146 14.3 8.0 35 9.5 7.0 18 14.3 5.5
97 733 7.9 6.0 54 17.0 11.0 7 7.9 8.0 57 7.4 5.0 17 6.5 5.0
98 1400 8.8 5.0 281 15.3 10.0 107 11.7 6.0 110 7.8 5.0 39 6.1 5.0
99 187 6.9 5.0 28 10.3 7.0 17 7.4 6.0 21 6.4 5.0 6 4.8 4.0
100 244 8.4 6.0 37 13.8 11.0 2 6.0 6.0 8 6.8 6.5 10 8.5 7.0
101 426 7.5 5.0 89 14.0 9.0 31 6.3 4.0 33 6.3 4.0 10 4.6 4.5
37
All patients Blunt multisystem Penetrating Isolated pneumothorax
Isolated mid-shaft femur fracture
N Mean Median N Mean Median N Mean Median N Mean Median N Mean Median
102 387 5.7 4.0 75 8.5 6.0 16 9.6 7.0 36 5.5 4.0 10 5.2 4.0
103 535 6.0 4.0 117 9.2 7.0 26 5.2 4.5 59 4.7 4.0 5 4.6 4.0
104 705 6.5 4.0 97 11.6 8.0 60 7.2 4.5 62 3.8 3.0 3 7.7 8.0
105 463 8.9 6.0 81 14.3 10.0 75 11.8 8.0 41 6.9 6.0 4 5.5 6.0
106 758 7.6 5.0 100 13.8 10.0 32 8.8 5.0 70 6.6 5.0 31 6.1 5.0
107 851 6.3 5.0 169 11.1 8.0 11 7.0 8.0 53 5.8 4.0 21 5.8 5.0
108 339 10.1 6.0 32 14.5 12.0 97 11.0 7.0 27 7.3 6.0 16 7.2 7.5
109 461 7.2 4.0 57 14.0 13.0 23 5.6 5.0 63 7.8 5.0 16 10.4 5.5
110 506 7.8 5.0 59 12.4 8.0 67 10.1 5.0 58 6.3 4.0 21 7.1 7.0
111 311 5.1 4.0 50 6.9 5.0 5 4.6 7.0 33 5.1 4.0 10 6.5 5.5
112 414 8.6 5.0 86 15.2 10.0 35 6.8 6.0 51 5.5 5.0 10 9.4 7.0
113 206 8.1 4.0 33 11.5 8.0 22 11.5 4.0 10 5.2 2.0 3 12.7 3.0
114 582 7.9 6.0 160 12.2 10.0 12 7.9 6.0 73 6.7 5.0 8 13.5 11.0
38
Table 8. Excess Length of Stay These data represent the proportion of patients with an excess LOS
TQIP Report ID All Patients Blunt multisystem Penetrating Isolated pneumothorax Isolated mid-shaft femur fracture
1 38.6 (32.8 - 44.6) 35.7 (12.8 - 64.9) 28.6 (10.4 - 54.0) 63.6 (30.8 - 89.1) 50.0 (9.8 - 90.2)
2 25.1 (23.0 - 27.3) 19.2 (13.5 - 26.0) 26.6 (18.6 - 36.0) 26.7 (17.9 - 37.0) 11.1 (3.1 - 26.3)
3 19.5 (17.1 - 22.0) 20.8 (14.6 - 28.2) 18.2 (10.2 - 28.9) 20.0 (2.5 - 55.6) 11.1 (2.0 - 31.0)
4 16.8 (14.4 - 19.4) 15.7 (10.1 - 22.8) 18.2 (6.5 - 36.9) 13.2 (6.2 - 23.6) 12.5 (2.3 - 34.4)
5 29.4 (25.8 - 33.2) 31.3 (20.2 - 44.1) 33.3 (17.8 - 52.1) 27.3 (13.3 - 45.5) 40.0 (15.0 - 69.6)
6 27.9 (24.8 - 31.3) 27.0 (16.6 - 39.7) 15.6 (9.7 - 23.2) 28.0 (16.2 - 42.5) 18.2 (3.3 - 47.0)
7 10.8 (7.9 - 14.4) 14.3 (4.8 - 30.3) 0.0 (0.0 - 52.7) 28.6 (3.7 - 71.0) 0.0 (0.0 - 45.1)
8 29.4 (25.0 - 34.0) 28.9 (16.4 - 44.3) 28.6 (16.4 - 43.6) 40.0 (19.1 - 63.9) 0.0 (0.0 - 39.3)
9 20.3 (16.9 - 24.2) 20.3 (11.8 - 31.2) 16.7 (8.6 - 28.1) 26.7 (12.3 - 45.9) 12.5 (0.6 - 47.1)
10 19.9 (16.5 - 23.7) 12.7 (6.0 - 22.7) 11.1 (0.6 - 42.9) 32.1 (15.9 - 52.4) 9.1 (0.5 - 36.4)
11 33.7 (30.5 - 36.9) 31.0 (20.5 - 43.1) 27.3 (12.6 - 46.8) 13.0 (2.8 - 33.6) 48.3 (32.0 - 64.8)
12 22.7 (20.8 - 24.6) 30.9 (25.1 - 37.3) 22.9 (13.4 - 35.1) 23.4 (14.5 - 34.4) 20.7 (9.4 - 36.8)
13 21.6 (19.3 - 24.1) 11.7 (7.6 - 16.9) 25.0 (13.7 - 39.6) 28.0 (18.2 - 39.6) 23.5 (12.3 - 38.5)
14 34.8 (30.5 - 39.3) 30.4 (17.7 - 45.8) 36.4 (24.3 - 49.9) 52.6 (28.9 - 75.6) 62.5 (28.9 - 88.9)
15 27.1 (23.7 - 30.8) 44.6 (33.0 - 56.6) 50.0 (2.5 - 97.5) 40.6 (23.7 - 59.4) 20.0 (5.7 - 44.0)
16 26.3 (22.4 - 30.4) 16.0 (7.2 - 29.1) 20.0 (5.7 - 44.0) 19.4 (7.5 - 37.5) 25.0 (4.6 - 60.0)
17 29.5 (25.9 - 33.2) 50.0 (35.2 - 64.8) 80.0 (49.3 - 96.3) 33.3 (14.6 - 57.0) 28.0 (13.9 - 46.2)
18 16.5 (13.1 - 20.2) 20.0 (9.6 - 34.6) 14.3 (0.7 - 52.1) 16.7 (3.6 - 41.4) 0.0 (0.0 - 23.8)
19 12.5 (8.7 - 17.2) 14.3 (0.4 - 57.9) NA 11.8 (1.5 - 36.4) 18.2 (3.3 - 47.0)
20 27.9 (24.9 - 31.2) 19.3 (11.7 - 29.1) 50.0 (22.2 - 77.8) 33.3 (21.7 - 46.7) 21.1 (7.5 - 41.9)
21 21.1 (19.6 - 22.6) 18.4 (15.1 - 22.0) 23.2 (15.1 - 33.1) 18.9 (13.1 - 25.8) 14.3 (5.8 - 27.7)
22 28.1 (25.1 - 31.2) 24.5 (16.4 - 34.2) 20.8 (8.6 - 38.9) 31.5 (19.5 - 45.6) 18.6 (9.6 - 31.1)
23 30.7 (27.0 - 34.6) 37.1 (27.1 - 48.0) 19.3 (11.2 - 29.9) 33.3 (15.6 - 55.3) 50.0 (15.3 - 84.7)
24 29.8 (26.6 - 33.3) 37.3 (25.8 - 50.0) 37.5 (11.1 - 71.1) 26.3 (16.9 - 37.7) 12.5 (2.3 - 34.4)
25 21.2 (19.9 - 22.5) 20.6 (17.6 - 23.8) 23.4 (19.1 - 28.2) 20.1 (14.4 - 26.8) 21.4 (13.7 - 31.1)
26 26.2 (23.4 - 29.2) 29.7 (21.6 - 38.8) 24.4 (13.9 - 37.9) 28.8 (17.1 - 43.1) 25.0 (7.2 - 52.7)
27 20.0 (18.0 - 22.1) 19.5 (14.5 - 25.2) 20.6 (10.1 - 35.2) 38.5 (13.9 - 68.4) 22.2 (10.1 - 39.2)
28 16.4 (13.3 - 20.0) 13.3 (3.8 - 30.7) 20.0 (1.0 - 65.7) 0.0 (0.0 - 60.2) 27.3 (7.9 - 56.4)
39
TQIP Report ID All Patients Blunt multisystem Penetrating Isolated pneumothorax Isolated mid-shaft femur fracture
29 22.5 (19.7 - 25.5) 20.9 (14.7 - 28.4) 11.1 (0.6 - 42.9) 11.8 (3.3 - 27.5) 16.7 (3.0 - 43.8)
30 26.7 (22.0 - 31.8) 30.0 (11.9 - 54.3) 0.0 (0.0 - 95.0) 46.4 (27.5 - 66.1) 13.3 (2.4 - 36.3)
31 13.3 (9.5 - 17.9) 0.0 (0.0 - 20.6) 0.0 (0.0 - 22.1) 29.4 (10.3 - 56.0) 0.0 (0.0 - 31.2)
32 31.4 (28.5 - 34.4) 28.7 (20.9 - 37.6) 20.8 (12.1 - 32.0) 28.3 (16.8 - 42.3) 30.8 (16.3 - 48.7)
33 23.0 (20.2 - 26.0) 26.2 (18.1 - 35.6) 9.1 (0.5 - 36.4) 19.1 (10.6 - 30.5) 10.0 (1.8 - 28.3)
34 24.6 (19.5 - 30.3) 19.2 (6.6 - 39.4) 19.2 (7.9 - 36.3) 23.1 (5.0 - 53.8) 28.6 (5.3 - 65.9)
35 30.4 (28.1 - 32.8) 30.2 (23.4 - 37.7) 29.0 (21.8 - 37.0) 43.5 (28.9 - 58.9) 20.6 (10.1 - 35.2)
36 23.9 (20.6 - 27.4) 27.3 (16.1 - 41.0) 25.0 (12.4 - 41.9) 22.4 (11.8 - 36.6) 21.1 (7.5 - 41.9)
37 30.0 (27.6 - 32.5) 30.9 (24.8 - 37.5) 28.4 (20.2 - 37.8) 26.4 (19.3 - 34.5) 39.4 (25.1 - 55.2)
38 37.6 (34.5 - 40.8) 48.5 (38.2 - 58.8) 65.0 (44.2 - 82.3) 20.0 (5.7 - 43.7) 83.3 (41.8 - 99.1)
39 32.4 (29.6 - 35.4) 32.3 (25.1 - 40.2) 26.2 (17.4 - 36.6) 32.9 (22.3 - 44.9) 37.5 (21.2 - 56.3)
40 25.8 (22.9 - 28.8) 24.3 (14.8 - 36.0) 24.1 (11.9 - 40.6) 20.6 (11.5 - 32.7) 17.6 (8.0 - 31.9)
41 37.8 (35.5 - 40.1) 34.9 (29.0 - 41.2) 39.3 (28.3 - 51.1) 37.4 (29.8 - 45.5) 37.5 (25.8 - 50.4)
42 23.1 (21.5 - 24.8) 21.5 (17.4 - 26.0) 20.7 (15.2 - 27.3) 24.0 (16.7 - 32.6) 21.4 (14.3 - 30.1)
43 17.5 (15.0 - 20.2) 13.3 (7.1 - 22.1) 14.3 (5.0 - 29.8) 27.8 (17.9 - 39.6) 0.0 (0.0 - 16.2)
44 37.4 (33.9 - 41.0) 45.8 (32.7 - 59.2) 36.8 (18.8 - 58.2) 49.0 (34.4 - 63.7) 31.3 (13.2 - 54.8)
45 14.2 (12.7 - 15.8) 13.4 (9.9 - 17.6) 13.3 (8.8 - 19.1) 12.0 (7.4 - 18.1) 11.5 (5.1 - 21.5)
46 16.0 (13.7 - 18.5) 27.5 (19.4 - 36.9) 33.3 (18.6 - 50.9) 20.5 (9.8 - 35.3) 13.3 (4.7 - 28.0)
47 18.6 (16.9 - 20.5) 18.8 (14.2 - 24.2) 30.0 (16.6 - 46.5) 20.4 (13.1 - 29.5) 10.3 (2.9 - 24.6)
48 28.3 (25.7 - 31.1) 29.4 (23.2 - 36.3) 18.0 (10.5 - 28.1) 31.0 (19.5 - 44.5) 24.2 (12.7 - 39.5)
49 30.1 (26.6 - 33.8) 35.5 (23.7 - 48.7) 22.7 (12.9 - 35.5) 42.5 (27.0 - 59.1) 30.0 (14.0 - 50.8)
50 28.5 (25.0 - 32.2) 27.2 (17.9 - 38.2) 21.1 (7.5 - 41.9) 20.0 (6.8 - 40.7) 16.7 (0.9 - 58.2)
51 26.0 (23.9 - 28.2) 23.1 (18.0 - 28.8) 24.1 (15.2 - 35.1) 14.6 (5.6 - 29.2) 23.3 (11.5 - 39.4)
52 36.8 (35.2 - 38.4) 29.7 (26.1 - 33.5) 27.7 (21.9 - 34.3) 38.7 (31.0 - 46.9) 39.5 (30.7 - 49.0)
53 34.1 (30.9 - 37.3) 38.9 (29.7 - 48.7) 38.5 (22.6 - 56.4) 25.6 (13.0 - 42.1) 14.3 (0.7 - 52.1)
54 28.0 (25.8 - 30.2) 21.9 (16.4 - 28.3) 19.8 (12.8 - 28.4) 18.9 (11.4 - 28.5) 28.6 (15.1 - 45.7)
55 27.9 (24.9 - 30.9) 26.0 (18.5 - 34.7) 38.5 (22.6 - 56.4) 40.4 (27.0 - 54.9) 11.5 (3.2 - 27.2)
56 22.6 (19.9 - 25.6) 19.6 (12.0 - 29.1) 26.3 (11.0 - 47.6) 8.7 (1.1 - 28.0) 26.7 (14.0 - 43.0)
57 17.2 (15.1 - 19.6) 13.0 (8.2 - 19.1) 18.5 (7.6 - 35.1) 21.4 (12.5 - 32.9) 3.6 (0.2 - 15.9)
58 23.2 (20.1 - 26.5) 28.8 (20.4 - 38.6) 0.0 (0.0 - 63.2) 13.6 (5.2 - 27.4) 0.0 (0.0 - 20.6)
40
TQIP Report ID All Patients Blunt multisystem Penetrating Isolated pneumothorax Isolated mid-shaft femur fracture
59 21.4 (19.4 - 23.5) 19.4 (14.7 - 24.7) 28.3 (20.9 - 36.7) 18.1 (11.8 - 25.9) 11.1 (3.1 - 26.3)
60 25.6 (22.9 - 28.4) 26.1 (19.1 - 34.1) 21.4 (6.1 - 46.6) 23.2 (14.6 - 33.8) 4.5 (0.2 - 19.8)
61 22.3 (20.4 - 24.4) 21.3 (15.4 - 28.3) 23.7 (12.9 - 37.7) 15.3 (9.6 - 22.6) 25.6 (14.6 - 39.6)
62 28.3 (25.4 - 31.4) 35.4 (25.1 - 46.7) 12.0 (5.4 - 22.3) 23.1 (13.5 - 35.2) 41.9 (26.9 - 58.2)
63 21.2 (19.4 - 23.2) 22.5 (17.3 - 28.3) 28.0 (13.9 - 46.2) 8.3 (0.2 - 38.5) 30.6 (18.2 - 45.5)
64 17.5 (15.5 - 19.8) 16.1 (10.8 - 22.8) 31.6 (14.7 - 53.0) 13.3 (7.1 - 22.1) 22.2 (10.1 - 39.2)
65 28.6 (25.6 - 31.8) 20.6 (15.3 - 26.7) 14.0 (7.2 - 23.9) 12.5 (0.3 - 52.7) 0.0 (0.0 - 39.3)
66 22.3 (19.2 - 25.8) 16.7 (7.0 - 31.4) 25.0 (4.6 - 60.0) 20.9 (10.0 - 36.0) 9.1 (1.6 - 25.9)
67 31.9 (28.2 - 35.8) 35.6 (23.6 - 49.1) 26.7 (14.0 - 43.0) 39.1 (19.7 - 61.5) 20.0 (7.1 - 40.1)
68 38.0 (33.3 - 42.9) 33.3 (20.0 - 49.0) 30.0 (16.6 - 46.5) 45.8 (25.6 - 67.2) 27.3 (7.9 - 56.4)
69 36.2 (33.9 - 38.5) 31.9 (26.3 - 38.0) 31.1 (25.5 - 37.3) 53.7 (42.3 - 64.7) 46.7 (33.8 - 59.9)
70 23.1 (19.1 - 27.5) 18.2 (7.0 - 35.5) 27.8 (11.6 - 49.8) 23.1 (11.1 - 39.3) 22.2 (4.1 - 55.0)
71 19.0 (15.8 - 22.6) 27.5 (15.9 - 41.7) 20.0 (3.7 - 50.7) 26.0 (14.6 - 40.3) 16.7 (3.0 - 43.8)
72 19.5 (17.4 - 21.8) 16.2 (11.1 - 22.4) 12.5 (3.5 - 29.2) 27.8 (9.7 - 53.5) 14.3 (5.0 - 29.8)
73 17.8 (14.5 - 21.6) 11.9 (4.0 - 25.6) 12.2 (4.9 - 23.9) 10.8 (3.0 - 25.4) 29.4 (12.4 - 52.2)
74 27.2 (24.9 - 29.7) 26.0 (19.6 - 33.3) 30.6 (18.2 - 45.5) 30.3 (21.8 - 39.8) 13.6 (3.8 - 31.6)
75 26.3 (23.8 - 29.0) 28.7 (21.6 - 36.6) 31.9 (20.8 - 44.8) 32.9 (22.3 - 44.9) 25.6 (15.1 - 38.8)
76 29.5 (26.9 - 32.1) 25.0 (19.2 - 31.6) 24.0 (18.0 - 31.0) 30.8 (18.7 - 45.1) 28.6 (13.2 - 48.7)
77 25.7 (22.7 - 29.0) 37.8 (26.8 - 49.9) 20.0 (1.0 - 65.7) 35.7 (12.8 - 64.9) 16.7 (0.9 - 58.2)
78 24.2 (19.9 - 29.0) 24.1 (13.9 - 37.2) 0.0 (0.0 - 31.2) 29.6 (13.8 - 50.2) 25.0 (4.6 - 60.0)
79 8.9 (6.7 - 11.4) 6.3 (2.1 - 14.0) 7.7 (0.4 - 31.6) 15.4 (5.9 - 30.5) 0.0 (0.0 - 17.1)
80 20.4 (17.9 - 23.1) 21.7 (15.4 - 29.1) 16.7 (4.7 - 37.7) 25.0 (13.2 - 40.3) 16.1 (6.6 - 31.0)
81 27.7 (25.5 - 30.1) 27.7 (21.5 - 34.7) 24.0 (16.1 - 33.5) 23.0 (15.8 - 31.4) 28.6 (16.4 - 43.6)
82 24.2 (21.9 - 26.6) 24.7 (15.8 - 35.5) 18.4 (9.9 - 29.9) 30.4 (22.2 - 39.7) 15.8 (4.4 - 35.9)
83 25.2 (22.6 - 27.9) 36.3 (27.8 - 45.4) 25.0 (13.1 - 40.6) 29.9 (19.3 - 42.3) 19.2 (7.9 - 36.3)
84 15.2 (13.0 - 17.6) 10.9 (6.1 - 17.5) 6.7 (0.3 - 27.9) 15.9 (6.6 - 30.1) 9.5 (1.7 - 27.1)
85 26.2 (22.5 - 30.2) 14.3 (4.8 - 30.3) 33.3 (6.3 - 72.9) 32.1 (15.9 - 52.4) 0.0 (0.0 - 19.3)
86 44.0 (40.6 - 47.3) 40.7 (27.6 - 55.0) 32.4 (23.0 - 42.9) 41.8 (29.8 - 54.5) 31.6 (19.3 - 46.1)
88 38.8 (36.0 - 41.5) 44.7 (37.6 - 51.9) 38.6 (29.9 - 47.9) 44.3 (32.4 - 56.7) 28.6 (15.1 - 45.7)
89 24.3 (22.5 - 26.2) 25.3 (21.1 - 29.9) 18.3 (10.6 - 28.5) 20.6 (15.2 - 27.0) 29.1 (19.2 - 40.8)
41
TQIP Report ID All Patients Blunt multisystem Penetrating Isolated pneumothorax Isolated mid-shaft femur fracture
90 38.5 (34.7 - 42.5) 41.2 (32.7 - 50.2) 33.3 (16.8 - 53.6) 32.5 (18.6 - 49.1) 37.5 (11.1 - 71.1)
91 28.0 (23.7 - 32.6) 32.5 (18.6 - 49.1) 50.0 (2.5 - 97.5) 34.6 (17.2 - 55.7) 0.0 (0.0 - 52.7)
92 22.0 (19.5 - 24.6) 21.6 (14.7 - 29.8) 23.5 (12.3 - 38.5) 28.1 (19.1 - 38.6) 20.0 (8.2 - 37.5)
93 41.1 (36.0 - 46.3) 39.7 (27.6 - 52.8) 14.8 (5.2 - 30.8) 31.3 (16.1 - 50.0) 50.0 (22.2 - 77.8)
94 25.6 (22.6 - 28.7) 38.3 (27.7 - 49.7) 16.9 (11.5 - 23.7) 13.8 (6.1 - 25.4) 30.8 (11.3 - 57.3)
95 21.0 (18.7 - 23.6) 18.2 (12.4 - 25.4) 16.4 (8.8 - 26.8) 22.0 (14.0 - 31.9) 28.6 (10.4 - 54.0)
96 39.6 (36.3 - 43.0) 47.4 (37.0 - 57.9) 29.1 (22.8 - 36.0) 40.0 (23.9 - 57.9) 23.5 (8.5 - 46.1)
97 37.9 (34.9 - 40.9) 40.0 (26.4 - 54.8) 71.4 (34.1 - 94.7) 29.8 (18.4 - 43.4) 17.6 (5.0 - 39.6)
98 27.7 (25.7 - 29.7) 31.1 (25.7 - 37.0) 29.8 (22.5 - 38.0) 26.4 (18.4 - 35.6) 12.8 (5.2 - 25.1)
99 28.3 (22.9 - 34.3) 25.0 (10.7 - 44.9) 23.5 (8.5 - 46.1) 42.9 (21.8 - 66.0) 0.0 (0.0 - 39.3)
100 39.9 (34.7 - 45.4) 43.2 (27.1 - 60.5) 0.0 (0.0 - 77.6) 37.5 (8.5 - 75.5) 20.0 (3.7 - 50.7)
101 25.1 (21.6 - 28.8) 37.9 (27.7 - 49.0) 12.9 (4.5 - 27.1) 24.2 (11.1 - 42.3) 10.0 (0.5 - 39.4)
102 17.1 (14.0 - 20.6) 14.9 (7.7 - 25.0) 25.0 (9.0 - 48.4) 16.7 (6.4 - 32.8) 20.0 (3.7 - 50.7)
103 23.5 (20.5 - 26.7) 21.6 (14.5 - 30.1) 23.1 (10.6 - 40.5) 20.3 (11.0 - 32.8) 0.0 (0.0 - 45.1)
104 16.7 (14.4 - 19.2) 15.8 (9.1 - 24.7) 13.3 (6.8 - 22.8) 16.1 (8.0 - 27.7) 33.3 (1.7 - 86.5)
105 23.2 (20.0 - 26.7) 21.5 (13.1 - 32.2) 20.5 (13.1 - 29.9) 39.0 (24.2 - 55.5) 25.0 (1.3 - 75.1)
106 24.2 (21.7 - 26.9) 17.3 (10.4 - 26.3) 12.5 (4.4 - 26.4) 24.3 (14.8 - 36.0) 16.1 (6.6 - 31.0)
107 16.3 (14.2 - 18.5) 15.0 (9.9 - 21.3) 18.2 (3.3 - 47.0) 15.1 (6.7 - 27.6) 23.8 (9.9 - 43.7)
108 37.3 (32.9 - 41.9) 43.8 (26.4 - 62.3) 33.0 (25.1 - 41.7) 55.6 (35.3 - 74.5) 56.3 (33.3 - 77.3)
109 26.0 (22.7 - 29.6) 29.8 (18.4 - 43.4) 13.0 (3.7 - 30.4) 31.7 (20.6 - 44.7) 18.8 (5.3 - 41.7)
110 25.9 (22.6 - 29.3) 28.1 (17.0 - 41.5) 19.7 (12.1 - 29.5) 25.9 (15.3 - 39.0) 28.6 (13.2 - 48.7)
111 15.4 (12.2 - 19.2) 4.0 (0.5 - 13.7) 40.0 (7.6 - 81.1) 21.2 (9.0 - 38.9) 20.0 (3.7 - 50.7)
112 29.8 (26.1 - 33.8) 23.2 (14.6 - 33.8) 20.0 (9.8 - 34.3) 27.5 (15.9 - 41.7) 50.0 (22.2 - 77.8)
113 24.6 (19.7 - 30.1) 24.2 (11.1 - 42.3) 23.8 (9.9 - 43.7) 30.0 (6.7 - 65.2) 33.3 (1.7 - 86.5)
114 29.1 (26.0 - 32.3) 32.1 (24.9 - 39.9) 16.7 (3.0 - 43.8) 26.0 (16.5 - 37.6) 37.5 (11.1 - 71.1)
42
Figure 23a. Excess Length of Stay – All patients excluding deaths (odd numbered IDs)
43
Figure 23b. Excess Length of Stay – All patients excluding deaths (even numbered IDs)
44
Figure 24a. Excess Length of Stay – Blunt multisystem excluding deaths (odd numbered IDs)
* Centers with estimated ELOS proportion of zero.
Pro
po
rtio
n o
f C
ases
wit
h E
xces
ss L
OS
wit
h 9
5% C
I
0
10
20
30
40
50
60
70
80
90
100
TQIP Report ID
19
31
111
79
57
73
13
45
43
85
107
47
3 95
59
21
7 103
27
9 65
25
29
71
51
63
113
99
105
61
91
89
33
81
75
55
37
35
5 69
41
11
39
83
109
67
101
23
77
49
1 97
15
53
93
**
**
Length of Stay - Blunt Multisystem
45
Figure 24b. Excess Length of Stay – Blunt multisystem excluding deaths (even numbered IDs)
* Centers with estimated ELOS proportion of zero.
Pro
po
rtio
n o
f C
ases
wit
h E
xces
ss L
OS
wit
h 9
5% C
I
0
10
20
30
40
50
60
70
80
90
100
TQIP Report ID
28
34
10
84
72
102
104
4 106
30
70
56
16
82
66
2 64
20
6 40
92
54
74
42
22
112
18
78
46
80
50
26
14
60
76
110
32
36
8 58
48
114
12
98
52
62
68
86
94
44
24
90
108
88
96
38
100
Length of Stay - Blunt Multisystem
46
Figure 25a. Excess Length of Stay – Penetrating excluding deaths (odd numbered IDs)
* Centers with estimated ELOS proportion of zero.
47
Figure 25b. Excess Length of Stay – Penetrating excluding deaths (even numbered IDs)
* Centers with estimated ELOS proportion of zero.
48
Figure 26a. Excess Length of Stay – Isolated pneumothorax excluding deaths (odd numbered IDs)
* Centers with estimated ELOS proportion of zero.
49
Figure 26b. Excess Length of Stay – Penetrating excluding deaths (even numbered IDs)
* Centers with estimated ELOS proportion of zero.
50
Figure 27a. Excess Length of Stay – Isolated mid-shaft femur fracture excluding deaths (odd numbered IDs)
* Centers with estimated ELOS proportion of zero.
51
Figure 27b. Excess Length of Stay – Isolated mid-shaft femur fracture excluding deaths (even numbered IDs)
* Centers with estimated ELOS proportion of zero.
52
Appendix A: Participating Hospitals
Advocate Condell Medical Center Pitt County Memorial Hospital
Advocate Good Samaritan POH Regional Medical Center
Advocate Good Shepherd Hospital R Adams Cowley Shock Trauma Center
Advocate Illinois Masonic Medical Center Regional Medical Center of San Jose
Advocate Lutheran General Hospital Research Medical Center
Akron City Hospital Riverside Regional Medical Center (CA)
Alaska Native Medical Center Riverside Regional Medical Center (VA)
AtlantiCare Regional Medical Center Robert Wood Johnson University Hospital
Banner Good Samaritan Medical Center Rockford Health System
Barnes-Jewish Hospital Saint Louis University Hospital
Baylor University Medical Center Houston Saint Mary's Health Care
Baystate Medical Center Saint Mary’s Hospital
Borgess Medical Center Santa Barbara Cottage Hospital
Bronson Methodist Hospital Scott & White Memorial Hospital
Carolinas Medical Center Scottsdale Healthcare Osborn Medical Center
Cedars-Sinai Medical Center Scripps Mercy Hospital
Charleston Area Medical Center Sentara Norfolk General Hospital
Christiana Care Health System Sharp Memorial Hospital
Deaconess Hospital, Inc. Sinai-Grace Hospital
Doctors Medical Center Spartanburg Regional Healthcare System
East Texas Medical Center St. Elizabeth Health Center
Fletcher Allen Health Care St. Joseph Mercy Hospital - Ann Arbor
Genesys Regional Medical Center St. Joseph's Hospital and Medical Center
Grady Memorial Hospital St. Luke's Adult Level I Trauma Center
Greenville Memorial Hospital St. Mary's Medical Center
Hennepin County Medical Center St. Michael's Hospital
Henry Ford Hospital and Health System St. Vincent Healthcare
Hospital of the University of Pennsylvania St. Vincent Mercy Medical Center
Huntington Memorial Hospital Stanford University Medical Center
Hurley Medical Center Stormont-Vail Regional Medical Center
Indiana University Health Methodist Sunrise Hospital and Medical Center
Inova Fairfax Hospital The Queen's Medical Center
Iowa Methodist Medical Center Truman Medical Center
IU/Wishard Memorial Hospital UC San Diego Medical Center
John C. Lincoln Hospital UCLA
John Muir Medical Center - Walnut Creek Campus UMASS Memorial Medical Center
Lahey Clinic University Hospital - Cincinnati
Lancaster General Hospital University Medical Center - Lubbock
Lee Memorial Hospital University Medical Center of Southern NV
Lehigh Valley Hospital University of Kansas Hospital
Loyola University Medical Center University of Kentucky Healthcare Enterprise
LSU Hospital/Spirit of Charity Trauma Center University of Michigan
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Maine Medical Center University of Mississippi Medical Center
Medical Center of the Rockies University of Missouri Health System
Medical University Medical Authority University of New Mexico Hospitals
Memorial Health University Medical Center University of North Carolina Hospitals
Memorial Hermann Hospital System University of Texas Medical Branch, Galveston
Memorial Medical Center - Modesto University of Utah Hospitals & Clinics
Moses Cone Hospital University of Virginia Health System
Munson Medical Center Ventura County Medical Center
New Hanover Regional Medical Center Virginia Commonwealth University Medical Center
North Colorado Medical Center Wake Forest University Baptist Medical Center
North Shore University Hospital Washington Hospital Center
OSF St. Anthony Medical Center West Virginia University Trauma Center
Palomar Medical Center Yale-New Haven Hospital
Parkland Health and Hospital System York Hospital
Parkview Trauma Center
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Appendix B: ACS TQIP Patient Inclusion/Exclusion Criteria Inclusion Criteria: (must meet all of the following criteria) • Age ≥ 16 years • At least one valid trauma ICD-9 code in the range of 800–959.9 (excluding late effects (905-909.9),
superficial injuries (910-924.9), and foreign bodies (930-930.9). • Primary mechanism of injury classified as either blunt or penetrating:
Blunt is defined as an injury where the primary E-code is mapped to the following categories: fall, machinery, motor vehicle traffic, pedestrian, cyclist, and struck by or against
Penetrating is defined as an injury where the primary E-code is mapped to the following categories: cut/pierce and firearm
• Severely injured patients with at least one AIS ≥ 3: For blunt injuries: at least one injury in any of the following AIS body regions: head, face, neck,
thorax, abdomen, spine, or upper and lower extremity. For penetrating injuries: at least one AIS ≥ 3 injury in any of the following AIS body regions: neck,
thorax, and abdomen. • Injury severity score (ISS)* ≥ 9 • ED discharge disposition AND hospital discharge disposition cannot both be unknown. Exclusion Criteria: • Comorbidity: pre-existing advanced directive to withhold life sustaining interventions • Isolated hip fractures: defined as any traumatic injury with at least one of the following diagnosis codes:
851810.3 Femur, Fracture, Intertrochanteric 851812.3 Femur, Fracture, Neck 851818.3 Femur, Fracture, Subtrochanteric
AND all other injuries are in AIS body region ‘External’ (i.e., bruise, abrasion, or laceration). Inclusion was further limited to patients 65 years or older with an injury with mechanism of Fall.
*AIS and Injury severity score (ISS) were calculated by NTDB using ICD-90 map only if participating center did not provide AIS in NTDB data submission.
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Appendix C: Prediction Models Mortality The following explanatory variables were included in the stepwise selection procedure for mortality prediction models for all patients, and the sub-populations of blunt multisystem and penetrating injuries: • Initial GCS motor score in ED • Initial systolic BP in ED • Initial pulse rate in ED • Mechanism of injury • Number of co-morbidities • Transfer status • Age (linear and quadratic terms) • Gender • Head injury severity (AIS) • Neck injury severity (AIS) • Chest injury severity (AIS) • Abdominal injury severity (AIS) • Lower extremity injury severity (AIS) • Spine injury severity (AIS) • Single Worst Injury (SWI)* *The SRR is the number of patients with a particular ICD-9 code who survive divided by the total number of patients who had that ICD-9 code. SRRs were derived only for codes in the 800 – 959.9 range (consistent with acute injury diagnosis). SRRs were estimated for each injury diagnosis and the lowest SRR for each patient was used in the model. This lowest SRR is referred to as the SWI for mortality – single worst injury. Model calibration and discrimination Model calibration is used to measure how closely the number of observed deaths agrees with the number of predicted deaths across each decile of mortality risk. A calibration curve that is closer to the perfect fit indicates better model fit. Calibration curves, along with their C-statistic, are shown below. The C-statistic reflects the ability of the model to discriminate between survivors and deaths. A C-statistic of 0.5 indicates the model has a discrimination power no better than the flip of a coin; a C value between 0.6 and 0.7 has a limited discrimination power; a C value between 0.7 and 0.8 implies a moderate discrimination power; and a C value of 1.0 indicates the model has perfect discrimination power. For a model to have acceptable discrimination power, the C-statistic must exceed 0.7.
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All patients including those classified as DOA or died in the ED Model discrimination: C-statistic 0.932
All patients excluding those classified as DOA or died in the ED Model discrimination: C-statistic 0.915
Ob
serv
ed m
ort
alit
y
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Predicted mortality
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
All Patients
Perfect fitTQIP Mortality Model
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Blunt multisystem injuries including those classified as DOA or died in the ED Model discrimination: C-statistic=0.913
Blunt multisystem injuries excluding those classified as DOA or died in the ED Model discrimination: C-statistic=0.895
Ob
serv
ed m
ort
alit
y
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Predicted mortality
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
Blunt Multisystem Injuries
Perfect fitTQIP Mortality Model
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Penetrating injuries including those classified as DOA or died in the ED
Model discrimination: C-statistic=0.969
Penetrating injuries excluding those classified as DOA or died in the ED
Model discrimination: C-statistic=0.936
Ob
serv
ed m
ort
alit
y
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Predicted mortality
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
Penetrating Injuries
Perfect fitTQIP Mortality Model
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Length of Stay The following explanatory variables were included in the length of stay prediction models for all patients, and the sub-populations of blunt multisystem, penetrating, isolated pneumothorax, and isolated mid-shaft femur fracture injuries: • Initial GCS motor score in ED • Initial systolic BP in ED • Initial pulse rate in ED • Mechanism of injury
Co-morbidities • Complications • Transfer status • Age • Payment type • Gender • Head injury severity (AIS) • Neck injury (AIS) • Chest injury severity (AIS) • Abdominal injury severity (AIS) • Lower extremity injury severity (AIS) • Spine injury severity (AIS) In addition to the variables listed above, injury severity adjustment variables were included in the model based on the ICD-9 injury diagnoses. A median LOS was estimated for each ICD-9 injury code. Each ICD-9 code was then assigned a weight based on its median LOS divided by the median LOS for the entire TQIP population. For each patient, the weights of the ICD-9 codes associated with the longest LOS were included in the model. Model Fit Generalized linear models with a negative binomial distributions and zero truncation were used to predict LOS. The degree of overdispersion did not permit the use of Poisson models. Manual backwards elimination of prediction variables in the model was used to identify the final model using all patients. The fit of the model was assessed by comparing the observed and expected number of cases with an ELOS.
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Appendix D:
TQIP Team
Management:
Avery Nathens Melanie Neal Julia McMurray Alice Rollins
Analytics:
LieLing Wu Emmanuel Eklou Chrystal Price
Education: Tammy Morgan
Consultants: Michelle Pomphrey Sandra Goble
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TQIP Leadership
COT Executive Committee
Quality and Data Resources Subcommittee
TQIP Training Project Team:
• Forrest Calland, Chair • Michelle Pomphrey • Heidi Hotz • Mike Pasquale • Clay Mann
TQIP Analytic Project Team: Avery Nathens, Chair Randy Burd David Clark Mark Hemmila Craig Newgard Clay Mann Shahid Shafi